Journal of Student-Run Clinics

Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic

Jennifer Bu — 2024-01-18

Background: Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients.

Methods: Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson’s correlation.

Results: Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR.

Conclusion: The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.

Providing Prenatal Care in a Student Run Free Clinic

Chloe Warpinski — 2024-02-07

Background: Prenatal care is a cornerstone of maternal and child health. This paper describes the creation of a free prenatal clinic for uninsured families following recognition of a significant disparity in birth outcomes in Alachua County, Florida including: the development of essential community re- source collaborations, clinical operations in a dual aim patient care-medical education site, preliminary outcomes after one year of clinical operation, identified challenges, and next steps for our growing program.

Methods: A retrospective chart review of all sixteen patients enrolled with the student run free prenatal clinic in its first year of clinical operation. Analysis included assessment of the prenatal care course using descriptive statistics. Specific dimensions assessed include timing of transition of care to a traditional obstetrics clinic, clinical findings and diagnoses identified at the prenatal clinic, and birth out- comes during the study period and report findings as descriptive statistics.

Results: The clinic has demonstrated the ability to identify and treat numerous pathologies which may impact maternal-fetal morbidity and mortality. The clinic has seen very high rates of patient retention and has demonstrated successful transition of patients to higher levels of care when indicated. Finally, the clinical model provides an uncommon opportunity for medical and physician assistant students to care for patients throughout the first 32 weeks of pregnancy and receive additional training in point-of-care ultrasound, diagnostics, and medical decision making.

Conclusion: While the small sample size limits the ability to assess the effectiveness of the prenatal clinic intervention, there are numerous promising features based on preliminary results.

Experiential Learning With Continuous Glucose Monitors: A Novel Curriculum for Volunteers in a Student-Run Free Clinic

Annie E Altman-Merino — 2024-02-14

Background: Growing evidence suggests that medical students and faculty preceptors have limited familiarity with continuous glucose monitors (CGMs), which may negatively affect how care teams counsel patients and monitor the use of CGMs. Although studies have shown that structured training for care teams may improve knowledge and comfort with various healthcare tools, to our knowledge, no study has attempted to do so for CGMs.

Methods: We designed a user experience course for medical students and faculty mentors to address this gap at a student-run free clinic. This course allowed twenty participants to wear a CGM for two weeks and participate in three interactive didactic sessions and group reflections. We evaluated how knowledge and comfort with CGMs among participants changed after the course with a survey and focus group.

Results: The cohort showed improvement in self-reported confidence in using the device, teaching patients how to use the device, and interpreting data (p<0.001). The majority of participants demonstrated improvement across all survey domains with higher post-intervention scores than pre-intervention scores. Qualitative analysis of group reflections elucidated three primary themes across participant experiences: the emotional impact of wearing the device, attitude changes with prolonged use, and behavior modification in response to glucose data.

Conclusion: This novel educational initiative may improve knowledge about CGMs, ability to counsel patients to use the device, and understanding patients' experiences among medical students and faculty mentors. We plan to expand this educational opportunity to additional clinic volunteers, include patient perspectives, and share the curriculum with other student-run clinics.

Assessment of Opioid Overdose Risk and Response Readiness Among Patients at a Clinic for Uninsured Patients

Benjamin Wrucke — 2024-02-27

Background: The opioid epidemic has been worsening. Fortunately, studies show that bystanders can effectively administer naloxone to reverse opioid overdose, and overdose education programs result in improved ability to respond to overdose. However, there has been limited research investigating opioid overdose risk and response preparedness among patients without insurance. This descriptive report aimed to assess risk of opioid overdose among patients without insurance in addition to their family members and close contacts and assess whether these patients, as crucial bystanders, were prepared to respond to opioid overdose.

Methods: Patients without insurance at a student-run free clinic completed an anonymous, voluntary survey during in-person appointments. Data were collected for eight months from 2021-2022. One-proportion Z-test compared respondent rates of opioid use with overall statewide community rates reported by the Wisconsin Department of Health Services (DHS) Opioid Dashboard. Subgroup analysis further described the data collected, and hypothetical number needed to screen (NNS) calculations explored possible screening methods for naloxone distribution.

Results: Seventy-two patients responded to the survey. The past-year rate of medically prescribed opioid use in the study population (12.5%) did not differ from the rate statewide (15.8%; p=0.44). Zero respondents reported personal opioid overdose in the past year, but six overdoses had been witnessed. Among respondents with family or close contacts who use opioids, 50% of those respondents who do not carry naloxone do not know where to get it, but 75% of those respondents who are not trained on how to respond to overdose would like to be. Lastly, screening for family or close contact opioid use offered the lowest hypothetical NNS of screening methods considered.

Conclusions: Patients without insurance at student-run free clinics, including those with family members or close contacts who use opioids, likely represent a target population for opioid overdose education and naloxone distribution.

Examining Factors Impacting Encounter Length and Missed Appointments at a Student-Run Free Clinic: A Retrospective Analysis

Joy Li — 2024-03-01

Background: St. Vincent's Clinic (SVC) is a free, student-run clinic affiliated with the University of Texas Medical Branch that has been an invaluable resource in providing free healthcare services to marginalized populations in Galveston, Texas. The clinic offers a wide variety of specialty services along with free resources such as transportation and medication assistance, telehealth options, and interpreter services. Despite these resources, the clinic has faced challenges with consistently high no-show rates and long encounter lengths, impacting overall efficiency and patient care. We aimed to explore factors that may contribute to these challenges and uncover opportunities to improve patient satisfaction and optimize clinic efficiency.

Methods: A retrospective chart review was conducted on all patients seen at SVC across all specialty clinics between March 2021 and March 2023. Patient demographics, appointment status, encounter length, language spoken, department specialty, and appointment modality were recorded. A series of statistical analyses were conducted on collected variables, including chi-square analysis, unpaired t-tests, and single-factor analysis of variance (ANOVA) tests, to assess significant associations.

Results: The average encounter length varies significantly across different spoken languages and specialty clinics, but no significance was observed between different appointment modalities. The no-show rates were significantly different depending on the appointment modality, specialty clinic, and patient language spoken. Notably, while the encounter length was significantly shorter for English-speaking patients, Spanish-speaking patients had a lower no-show rate and were more likely to keep scheduled appointments.

Conclusions: Language barriers and specialty clinic types can impact the encounter lengths and no-show rates, highlighting the need for targeted interventions such as proper resource allocation. Limitations include potential data discrepancies from factors such as human error or variations in documenting appointments. Future research should explore patient perspectives and experiences to improve patient satisfaction and overall optimize clinic operations.

Ophthalmology Encounters During the COVID-19 Pandemic in a Student Run Free Clinic

Anindya Samanta — 2024-03-12

Background: Ophthalmology services at student run free clinics (SRFC) serve an important role for the socioeconomically underserved within a city. The coronavirus disease 2019 (COVID-19) pandemic has worsened gaps in care for ophthalmology tertiary clinics, but its effects on ophthalmology encounters at SRFCs are not known.

Methods: This was a retrospective chart review from a single center that compared patient encounters in the ophthalmology SRFC six months prior to its closure (pre-COVID group) with patient encounters in the ophthalmology SRFC six months after its reopening (post-COVID closure group).

Results: There was a decline (47.3%) in the number of encounters in the post-COVID closure group (n=20) when compared to the pre-COVID group (n=38). While the number of encounters for routine screening stayed about the same in both groups, there was a 90.5% decline in encounters with active disease (21 pre-COVID vs. 2 post-COVID closure). Sub-group analysis of the pre-COVID group showed that patients with active disease tended to have worse vision (-0.33 logMAR, p=0.034 OD; -0.27 logMAR, p=0.048 OS) than those undergoing routine screening.

Conclusions: Patients in West Texas with active eye diseases are not presenting to SRFC after its reopening. Early recognition of this is critical to address the potential gap in care in a vulnerable population.

Anxiety and Depression Prevalence in Free Clinic Patients

Jack Kovarik — 2024-04-14

Background: Disparities in mental health services are often observed in under-resourced low-income communities, which are at an increased risk for compromised mental health. By surveying patients at JayDoc Free Clinic, a student-run free clinic (SRFC) in Kansas City, Kansas, this study sought to as-sess the prevalence of depression and anxiety and compare screening outcomes among various de-mographic groups seeking safety-net care.
Methods: From May through November 2022, patients aged 12 and older were offered a Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and demographic survey. Demo-graphic variables included household income, gender, insurance status, and race and ethnicity. GAD-7 and PHQ-9 questionnaire scores were categorized into minimal, mild, moderate, or severe catego-ries. Relationships between demographic variables and scores on screening questionnaires were an-alyzed using multivariable analyses, with linear regression and analysis of variance one-way tests for significance (p-value <0.05).
Results: Of 232 participants who consented to the study, 222 completed the GAD-7 and 228 com-pleted the PHQ-9. In comparison to 2019 United States national data, the percentage of respondents experiencing anxiety and depression was greater across all severity classifications. Approximately 18.1% reported symptoms of moderate to severe anxiety and 21.5% reported symptoms of moderate to severe depression, compared to national distributions of 6.1% and 7%, respectively. Of 232 participants, 54 completed the demographic survey. There was no correlation between PHQ-9 scores or GAD-7 scores and gender, household income, insurance status.
Conclusion: While no association was identified between screening outcomes and demographic var-iables, the findings that the prevalence of anxiety and depression at JayDoc SRFC is greater than na-tional rates reaffirm the need for accessible mental health services for patients receiving care at SRFCs. This study provides insight into the status of mental health in an SRFC patient population and discusses mental health screening implementation at SRFCs.

A Roadmap to Integrating Dermatologic Care at a Student-Run Free Health Clinic

Yacine Sow — 2024-01-03

Student-run free health clinics (SRFCs) play an important role in providing a safety net healthcare system for uninsured patients by offering primary healthcare or preventative medical services. Patients at free clinics may have to be referred out for medical complaints better managed with specialty care. Integrating these services at SRFCs can address barriers to accessing specialty care. Free dermatologic care offers an opportunity to provide care to patients who may otherwise ignore symptoms, which can lead to reduced quality of life and a worse prognosis in some conditions. We detail a roadmap to integrate dermatologic services at an SRFC by providing operational considerations such as assessing needs, developing a clinical workflow, engaging dermatologists and the community, and sustaining student involvement. We also discuss the potential for a dermatology clinic to foster interest in the specialty among students underrepresented in medicine, given the current call to action to increase racial and ethnic diversity in the dermatologic workforce.

Calling All Coyotes: An On-Call Model for Student-Run Free Clinics

Tiffany Bender — 2024-02-05

To mitigate transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the pandemic, many ambulatory healthcare practices were either deferred or temporarily discontinued. Concern surrounding exposure risk to the virus has also deterred patients from seeking elective or preventative care. Similarly, medical schools were forced to rapidly adapt and develop protocols to protect students that suspended direct patient contact, especially if this experience was deemed elective to their primary academic requirements. At the intersection of these challenges to providing safe patient care and didactic training for students were student-run free clinics. The Coyote Clinic is a medical student-run clinic affiliated with the University of South Dakota Sanford School of Medicine and Avera Medical Group Health Care Clinic that provides free, basic healthcare services and screening to uninsured community members of the greater Sioux Falls, South Dakota area. On the heels of the coronavirus disease 2019 (COVID-19) pandemic, a decreased patient volume forced multiple instances of closures at the Coyote Clinic. In an effort to catalyze the return of patients to the clinic and enhance the educational enrichment for the student volunteers, a novel on-call workflow was devised that prioritizes walk-in patients. This on-call model is more attractive to attending physician volunteers and offers an alternative learning avenue for trainees. Here, we describe the new model we have implemented at the Coyote Clinic for other student-run free clinics that may be facing similar barriers in re-establishing themselves in their communities.

Building a No Cost Undergraduate Community Speech Clinic

Meagan Spencer — 2024-03-11

Aim: This study aimed to explore the clinic learning models through student perspectives using that insight to explore how these students viewed a newly established speech clinic program and understand the organizational and learning benefits and limitations of the clinic and how it can be improved for future service for student learning.

Methods: This exploratory study utilized an observation analysis to understand how the student-led functioning of the clinic fits into both the learning models of Bloom’s Taxonomy and Bandura’s Triadic Reciprocal Model of Causality and the factors that contribute most to these learning models. These models were chosen due to the systemic and progressive nature of learning that reflects the academic mission of the university’s accrediting body: the Southern Association of Colleges and Schools Commission on Colleges. A mixed closed and open-ended student questionnaire was utilized to gain insight into themes that influence the student-led learning model.

Results: The clinic was overall seen as a place of relationship building and skills development. The main contributors to this relationship-building and skills development lie in the ability of students to apply what they have been learning in the classroom to a functional situation, as well as the opportunity to serve the community and build confidence and leadership skills.

Conclusion: Student leadership roles in the clinic are leading to self-efficacy which is seen in the highest level of Bloom’s Taxonomy and Bandura’s Triadic Reciprocal Model of Causality.

Establishing the First Student-Run Clinic to Provide Free Health Care to a South Texas Colonia

John Nicholas Cauba — 2024-04-08

The University of Texas Rio Grande Valley School of Medicine (UTRGVSoM) opened its student-run clinic (SRC) in March 2018 to provide free health care for the residents of Pueblo de Palmas colonia in Hidalgo County. Located along the United States-Mexico border near some of the country's poorest and most medically underserved communities, UTRGVSoM has the unique opportunity to extend quality primary care to those who otherwise would go without. The physical location of the clinic was determined by a partnership with Proyecto Desarrollo Humano, a nonprofit organization within the Pueblo de Palmas colonia. The free clinic, located in the town’s community center, opens its doors to the public every month on a chosen Saturday. This article hopes to detail the experience of being the first SRC to operate inside a Texas colonia.